Although there have been numerous calls for better practitioner training in substance abuse, no systematic efforts have been directed at developing and evaluating methods to accomplish this training. In no area is this lack of attention perhaps more important to overcome than in regard to pregnant women's health and the health of their unborn offspring. The overall aim of this proposed four-year project is to implement and evaluate, in a delayed treatment-control randomized design, an intervention to promote recognition, counseling and referral of substance abuse problems in community obstetric-gynecological practices. The ultimate goal is to develop an intervention that will promote behaviors to improve recognition, counseling, and referral of substance abuse problems and be capable of dissemination to obstetric practices. We propose to randomize 18 practices to two cohorts (Cohort A and Cohort B with 9 practices/cohort), with each cohort receiving the intervention for six months, first with Cohort A and then after one year with Cohort B. Unit of randomization and analysis will both be practices. Our first primary hypothesis is that there will be an increase in substance abuse recognition within obstetric practices as they receive the intervention and between those that receive versus those that have not received the intervention (during the period of delayed intervention) as evidenced by increased chart documentation of: a) a prior history of problems with alcohol, drugs, and tobacco; b) a family history of substance abuse; c) pregnant women reporting they live with someone who abuses drugs or alcohol; and d) laboratory orders (i.e., MCV, GGT, urine drug screen). Our second primary hypothesis is that there will be increased counseling by obstetric practitioners of substance abuse issues with pregnant women as evidenced by increased chart documentation of counseling and increased practitioner-reported counseling. Primary and secondary outcome measures will be obtained to characterize all practices at three points in time: prior to any intervention, after intervention with Cohort A, but prior to intervention with Cohort B, and then after intervention with Cohort B. Comparisons made with these data will allow us to determine immediate intervention effects maintenance of the intervention effects, and replicability of the intervention across the two practice cohorts. The proposed intervention will involve systematic components directed at predisposing (communicating and disseminating information), enabling (facilitating the desired changes in the practice sites), and reinforcing (by reminders and feedback) components. Specific aims for the proposed project include: a) To conduct planning and development activities; b) To recruit 18 community obstetric practices from the Birmingham, Alabama, 5-county standard metropolitan statistical area; c) To collect baseline and follow-up data on our proposed primary outcome measures of indices for each practice (i.e., physicians and office staff) including: 1) clinical behaviors regarding the assessment and recognition, counseling, and referral of substance abuse problems; 2) knowledge of substance abuse problems and assessment and counseling procedures; and 3) attitudes and perceptions towards the assessment and management of substance abusing patients; and d) To implement a physician and staff training program designed to promote substance abuse practice behaviors in accordance with the overall delayed, treatment controlled design.